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April in Paris: Voyager Avec Enfants (Day Five)
" A touts les glories de la France. "Coming into this trip, I scheduled two guided tours, and deliberately put them at the end of the trip. I wanted to leave things a little open-ended and less time-pressured at the start of the week, just to allow for jet lag and child recalcitrance and the general unpredictability of kid life. However, Idid have two organized excursions I wanted for us to do, the first of which was a bike tour of the grounds at the Palace of Versailles.Generally speaking, there's enough in the city of Paris to do with kids, particularly if you're only planning to be here for less than a week, a...
Source: the underwear drawer - April 7, 2017 Category: Anesthesiology Authors: Michelle Au Source Type: blogs

H. pylori, a true stomach “bug”: Who should doctors test and treat?
In 1982, two Australian scientists discovered that a certain bacterium, Helicobacter pylori, was a common cause of persistent stomach inflammation and stomach ulcers. This realization revolutionized ulcer treatment. While fairly common, this infection usually causes no symptoms, but it can sometimes lead to ulcers in the stomach or the very first part of the small intestine (duodenum), and to certain types of stomach cancer. There is also evidence linking H. pylori infection to other conditions like iron-deficiency anemia and vitamin B12 deficiency. The bacteria are thought to spread through contaminated water, vomit, or f...
Source: Harvard Health Blog - April 5, 2017 Category: Consumer Health News Authors: Wynne Armand, MD Tags: Digestive Disorders Health Infectious diseases Tests and procedures Source Type: blogs

Answer to Case 436
Answer:Ascaris lumbricoidesAlthough we don't have the worms to examine in this case, the presence of multiple large tan-white worms with a smooth outer cuticle within the lumen of the intestine is strongly consistent withA. lumbricoides.The femaleA. lumbricoidescan get quite large, reaching lengths of 35 cm!One reader also raised the possibility of anisakiasis given that these worms were found on an upper endoscopy. However, the large size would exclude anisakid larvae given that they only reach a few centimeters in length. Also, the presence of multiple worms would be unlikely for anisakiasis, since usually only 1 la...
Source: Creepy Dreadful Wonderful Parasites - February 27, 2017 Category: Parasitology Source Type: blogs

The uncertain diagnosis is difficult for everyone involved
It is frustrating for patients to have unanswered questions, and it is equally frustrating for doctors to not have answers to their questions. In the past month, I have cared for three patients who have stood out to me because they have all presented under personally dire situations. “I have had crushing 10/10 chest pain since this morning,” Ms. A tells me at the urgent episodic appointment she scheduled in my evening primary care clinic as she is bent over in her chair, grimacing in pain. Ms. A came to the hospital because of worsening, disabling chest pain that frequently woke her up while she slept and preve...
Source: Kevin, M.D. - Medical Weblog - December 4, 2016 Category: Journals (General) Authors: < a href="http://www.kevinmd.com/blog/post-author/michael-nguyen" rel="tag" > Michael Nguyen < /a > Tags: Education Medical school Source Type: blogs

Falling Upward and Embracing the Second Half of Your Life
There comes a moment in every person’s life when she realizes she has just entered the second half of her life. With the average lifespan of a woman in the United States being 81, I technically crossed that line three years ago. Yes, that’s when my waist disappeared and the pregnancy questions started; my squiggly gray hair came in and I purchased my first pair of readers; I started doing things like placing ketchup in the freezer and cereal in the refrigerator; and the medical appointments on my calendar started to outnumber the social gatherings by a ratio of about 10 to 1. A month ago, I went through the rit...
Source: World of Psychology - August 24, 2016 Category: Psychiatry & Psychology Authors: Therese J. Borchard Tags: Aging Depression Inspiration & Hope Mental Health and Wellness Personal Bipolar Disorder Source Type: blogs

MKSAP: 68-year-old woman with dyspepsia
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 68-year-old woman undergoes upper endoscopy for evaluation of dyspepsia. She has a history of pernicious anemia. She has no other medical problems and her only medication is oral vitamin B12. On physical examination, vital signs are normal, as is the remainder of the physical examination. Upper endoscopy discloses a 6-mm polyp in the body of the stomach, which is removed by polypectomy. Other endoscopic findings, including biopsy of the duodenum to evaluate for celiac disease, are normal. Pathologic ex...
Source: Kevin, M.D. - Medical Weblog - June 18, 2016 Category: Journals (General) Authors: Tags: Conditions Cancer GI Source Type: blogs

CMS Proposed Patient Relationship Categories for MACRA
Patient engagement and patient satisfaction have been a core principle of healthcare reform under ACA and MACRA. The Centers for Medicare and Medicaid Services (CMS) recently released for public comment its proposed physician-patient relationship categories, a first step toward a Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requirement that the agency establish classification code sets for such physician-patient relationships. The patient relationship categories and codes are intended to help CMS more effectively measure resource use, a major performance category under the Merit-based Incentive Payment Syst...
Source: Policy and Medicine - May 18, 2016 Category: American Health Authors: Thomas Sullivan - Policy & Medicine Writing Staff Source Type: blogs

MKSAP: 50-year-old man with a large bleeding gastric ulcer
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up after hospitalization 6 months ago for a large bleeding gastric ulcer. Tests performed for Helicobacter pylori infection at that time were negative. However, for the 3 months before hospitalization he had been taking ibuprofen for chronic back pain. He was discharged from the hospital on omeprazole, and his ibuprofen was discontinued. Owing to the large size of the ulcer and increased suspicion for underlying malignancy, follow-up upper endoscopy was perfo...
Source: Kevin, M.D. - Medical Weblog - January 16, 2016 Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs

Maybe health costs should be a quality measure
How do we measure a doctor? Hospital length of stay? Infection rate? Flu shot compliance? Waiting time? These reality surrogates do not tell us how a patient feels or the quality of life. They are complex to measure, require major data crunching and may not focus on an individual physician. This week, two patients reminded me of a basic screening tool for good care: How much is the bill? 15 years ago, I took care of Melissa for gallbladder cancer. She received surgery, radiation and has been in remission ever since. In fact, because she has no need of a grouchy oncologist, I have not seen her in years. Melissa works f...
Source: Kevin, M.D. - Medical Weblog - August 25, 2015 Category: Journals (General) Authors: Tags: Conditions Cancer Source Type: blogs

MKSAP: 55-year-old man with gastroesophageal reflux symptoms
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 55-year-old man is evaluated for a 6-year history of typical gastroesophageal reflux symptoms treated on an as-needed basis with a proton pump inhibitor. However, the frequency of his reflux symptoms has recently increased and his episodes do not respond to treatment as completely as in the past. An upper endoscopy is scheduled to evaluate the cause of this change in his symptoms. Endoscopy reveals a 4-cm segment of salmon-colored mucosa in the distal esophagus. Biopsy from the salmon-colored segment r...
Source: Kevin, M.D. - Medical Weblog - March 29, 2015 Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs

Stomach Pain: It Continues – Part II
Part I can be found by clicking here: Stomach Pain: It Starts – Part I. ***** We sat quietly waiting in the waiting room. Again, we found ourselves in an odd position of being on the patient end of things. Allison, my wife, is a registered nurse. At the time she was working as an RN on a cardiac unit and I was at the end of my second year of Internal Medicine residency. Also, before this GI appointment, Allison had made a 2nd visit to the LLUMC ED. On that second visit they had decided to admit her to the Family Medicine service since her primary doctor was from the Family Medicine service. They did what they could ...
Source: JeffreyMD.com - February 23, 2015 Category: Internal Medicine Authors: Dr. Jeff Tags: My Life abdominal pain EGD esophagogastroduodenoscopy gastroenterology HIDA scan stomach pain thewife Source Type: blogs

MKSAP: 50-year-old man with cirrhosis
Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 50-year-old man is evaluated in follow-up for a recent diagnosis of cirrhosis secondary to nonalcoholic steatohepatitis. He has a history of asthma, type 2 diabetes mellitus, hyperlipidemia, and obesity. His current medications are inhaled fluticasone, montelukast, insulin glargine, insulin lispro, simvastatin, and lisinopril. On physical examination, temperature is 37.5 °C (99.5 °F), blood pressure is 120/70 mm Hg, pulse rate is 80/min, and respiration rate is 16/min; BMI is 31. Abdominal exam...
Source: Kevin, M.D. - Medical Weblog - December 13, 2014 Category: Journals (General) Authors: Tags: Conditions GI Source Type: blogs

Esophageal cancer: How far should we screen?
The incidence of esophageal adenocarcinoma has increased more than five-fold over the past four decades in the U.S. While the rate of rise in incidence of esophageal cancer has slowed somewhat in recent years, this malignancy is still associated with a dismal prognosis. Barrett’s esophagus, the precursor lesion to esophageal cancer, is easily identifiable on routine upper endoscopy and can be monitored for the development of precancerous changes. We generally assume that by performing endoscopic surveillance in our Barrett’s patients, we can detect high-grade dysplasia and esophageal cancer at early stages when...
Source: Kevin, M.D. - Medical Weblog - June 1, 2014 Category: Journals (General) Authors: Tags: Conditions Cancer GI Source Type: blogs

Fecal transplants taken up by American Hospital Association in letter to HHS about Medicare/Medicaid
Interesting discussion of Fecal Transplants is this letter from the American Hospital Association to HHS about Medicaid / Medicare: Marilyn Tavenner September 6, 2013 Page 1 of 33 September 6 ... Key text is below: "FECAL MICROBIOTA TRANSPLANTATION Fecal microbiota transplantation (FMT), also known as fecal bacteriotherapy, or human probiotic infusion, is a medical treatment for patients with Clostridium difficile (C. difficile) enteritis or ulcerative colitis. C. difficile infection occurs in patients who have been administered antibiotics for a long period of time. The antibiotics dest...
Source: The Tree of Life - September 7, 2013 Category: Medical Scientists Authors: Jonathan Eisen Source Type: blogs